What Is Vulvodynia–and Could It Be Making Sex Painful?
Vulvoydynia is a term used to describe unexplained vagina or vulva pain. Quick refresher: The vulva is the external female genitalia including the clitoris and the labia at the entrance to the vagina, which is the internal canal connecting the cervix to the outside of the body.
“Vulvodynia is a broad classification for a series of disorders that cause pain in the vulva and in the vagina,” says Anuja Vyas, MD, an ob-gyn and specialist in vulvar and vaginal disorders at Houston Methodist Hospital. “It’s a catch-all term for pain in that area.”
For many women who have vulvodynia, the pain is so intense they can’t have sex. Some women also have trouble exercising or even sitting for long periods of time. If left untreated, vulvodynia can lead to anxiety, depression, problems sleeping, poor body image, and relationship problems. Here’s what women need to know about the painful condition.
No one knows exactly what causes vulvodynia. However, certain factors seem to contribute, including yeast and other vaginal infections, skin allergies and sensitivity, hormonal changes, spasms or weakness in the muscles that support your pelvic area, nerve damage (maybe from childbirth), sensitivity to certain foods, and surgery or other trauma in the vaginal area. Sometimes a slipped disc in the spine can refer pain to the vulva.
There are also different types of vulvodynia. You can have generalized pain throughout the whole vulvar area, or localized pain confined to just one section. Vulvar pain can be unprovoked, meaning the pain happens for no known reason, called generalized vulvodynia. Or, it can be triggered when something touches the opening to the vagina, called vestibulodynia. This pain can be caused by sexual activity, a tampon, too-tight pants, or gynecological instruments–or even by wiping after going to the bathroom.
Pain in the vaginal area from vulvodynia can be described in many ways, says Jennifer Wu, MD, an ob-gyn at Lenox Hill Hospital in New York City. Sometimes it’s burning vaginal pain, other times sharp pain, stinging, soreness, or a dull throbbing pain. Usually, the vulva looks totally normal–but sometimes it can be a little inflamed or swollen with vulvodynia.
Vulvar pain can be mild, or it can be so severe it’s hard to sit down or sleep.
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In order to get a diagnosis of vulvodynia, the vaginal pain has to have lasted for at least three months. Your doctor will ask questions about your symptoms and sexual and medical history to check for other possible causes of vaginal pain first, some of them serious.
“If you have vulvar pain, we want to rule out precancerous or cancerous conditions, nerve entrapment, and bad infections,” says Dr. Wu. That might involve a blood test to assess hormone levels, a pelvic exam, or a tissue sample for biopsy.
There’s no cure for vulvodynia, but there are multiple treatments. Treatment has to be individualized for each patient, says Dr. Vyas, and often more than one approach is needed.
Doctors often start with local anesthetics like lidocaine cream, which numbs the painful area and can be especially helpful before sex.
Medications are another option, including different types of antidepressants, anti-seizure drugs, and hormone creams. Steroid or anesthetic injections can help with pain relief, and Botox may relax the muscles of the pelvic floor.
Physical therapy to relax the pelvic area can be “invaluable,” says Dr. Vyas. Biofeedback is a type of physical therapy that teaches you how to strengthen the pelvic-floor muscles. Cognitive behavioral therapy has also been shown to reduce vulvar pain and help women cope with depression and anxiety, which can accompany vulvodynia. Sexual or relationship counselors can help support you and your partner.
If other treatments don't work, doctors sometimes try surgery to remove the painful tissue. This is usually a last resort and can only be used for localized pain.
“Sometimes it takes a really concerted effort with biofeedback, physical therapy, and a combination of [other treatments], but we usually are able to improve quality of life,” says Dr. Wu.
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Vulvodynia home remedies
Other vulvodynia remedies don’t require a doctor or surgeon’s involvement. For instance, some women say they get relief from taking lukewarm baths. “It can help you relax the muscles,” says Dr. Wu. “But you don’t want to do anything to dry out your skin or irritate it.”
Avoid irritants by staying away from detergents, shampoos, and soaps with dyes or scents and avoid fabric softener, bubble baths, vaginal wipes, tight paints, and, importantly, douching. “The vagina is self-cleaning, so you don’t have to do much to keep it working properly,” says Dr. Vyas.
Wear 100% cotton underwear–in white–during the day and don’t wear any underwear at all at night. “The reason we say white is because sometimes dyes can be hyper-allergenic,” says Dr. Vyas.
Try patting yourself dry after urinating, and avoiding staying in wet bathing suits or sweaty workout gear for too long.
Lubricants can help with painful sex (as long as they don’t have potentially irritating flavors or warming or cooling properties), while cool ice packs applied to the area may lessen vaginal pain.